Tetanus (Lockjaw)

Tetanus is a vaccine-preventable disease caused by the bacterium Clostridium tetani, which releases toxin that affects the brain and spinal cord. The bacteria live in the soil and are found worldwide. The organism is a harmless inhabitant in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. In the soil, they can remain infectious for more than 40 years. The disease is characterized by generalized rigidity and convulsive spasms of skeletal muscles. Tetanus is not communicable from person to person.

Infection begins when the bacteria are introduced into an open injury or wound where they produce a toxin called tetanospasmin. Tetanospasmin blocks messages from the spinal cord to the muscles, forcing muscles to go into severe spasm. Tetanus often begins with mild spasms in the jaw muscles, neck muscles, and facial muscles. Stiffness rapidly develops in the chest, back, and abdominal muscles. Tetanus is usually associated with stepping on rusty nails or metal. Chances are if the object is rusty, it is also dirty. It is not the rust but the dirt on the nails or metal that carries the bacteria and causes the infection.

About 100 cases and approximately five deaths of tetanus occur every year in the U.S., the vast majority in unimmunized individuals or those who do not have current immunizations. Worldwide, there are 1 million cases annually. In developing countries, tetanus frequently causes death in newborn infants when the umbilical stump becomes infected.

Symptoms for tetanus usually appear within two weeks of infection and may include:

• Spasms and tightening of the jaw muscle or "lockjaw"
• Stiffness and spasms of muscles

  Neck muscles
  Chest muscles
  Abdominal muscles
  Back muscles, often causing arching

• Seizures
• Irritability
• Fever
• Excessive sweating
• Difficulty swallowing

Without treatment, one out of three affected people dies. The mortality rate for newborns with untreated tetanus is even higher: two out of three. With proper treatment, less than 10 percent of infected patients die, but the muscle spasms make for a long recovery.

Tetanus is completely preventable with tetanus immunization. Children six weeks through six years of age should be given tetanus immunization in combination with diphtheria and pertussis vaccines (DTaP). A tetanus/diphtheria (Td) or tetanus/diphtheria/pertussis (Tdap) booster follows five to ten years later, followed by a booster every ten years throughout life.